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WASHINGTON—Anita Bacon was once a 15-year-old Alabama dairy farmer, and she has never been much for towns, forget cities. She lives with her husband in a little house in middle-of-nowhere Arkansas, a speck of a place so small it hasn’t even earned a population sign. Like most of the people around, the owner of the Backwoods BBQ votes Republican.

But she thinks she might be alive only because of the Democrat who is leaving the White House on Friday. And what she hears from his Republican successor, two weeks before her second breast reconstruction surgery, is stressing her out.

Bacon, 43, just survived cancer. She credits God. And Obamacare.

“The insurance has really, really, really helped me, and it’s something that’s really weighed heavy on my mind. What’s going to happen with it?” she said Thursday. “I’m hoping the new president-elect will keep the people that really, really need it. Well, I think everybody needs it, to be honest.”

Pleas like Bacon’s show why it will be tricky for Donald Trump and his congressional allies to fulfil their promise to quickly “repeal and replace” President Barack Obama’s polarizing health law — at least without some chest pains and heart palpitations. Ending the Affordable Care Act risks an uproar from a chunk of their own base.

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The Republicans’ political challenge has been reflected in their sudden outbreak of public concern about the ramifications of getting rid of a law many have long called a worthless disaster. The optics problem was illustrated most dramatically at a town hall on CNN on Thursday night, when a former Ronald Reagan campaign worker confronted House Speaker Paul Ryan with the story of how Obamacare saved his life.

Trump, who vaguely promises some sort of new program “far less expensive and far better,” is demanding that Congress immediately get on with the repealing and replacing. But even the hard-line conservatives of the House Freedom Caucus are urging caution. Their nightmare: a parade of sick Republicans on the local news, accusing their congressman of making them suffer.

Congress took a first step toward repeal on Friday, with the Republican-controlled House approving a budget measure that will later allow them to scrap much of the law even if there continues to be unified Democratic opposition. Ryan called Obamacare “so arrogant and so contrary to our founding principles,” and he said he was conducting a patient-focused, cost-cutting “rescue mission” for a program he said is “collapsing.”

There are political benefits, too, to eliminating a law opposed by most conservatives and plagued by recent increases in cost and decreases in choice. In conservative Arkansas, where Mitt Romney earned 61 per cent to Obama’s 37 per cent, Obamacare is so toxic that even Democrats have run campaign ads boasting that they opposed it. Obama himself acknowledges the law has “real problems.”

“The ‘Unaffordable’ Care Act will soon be history!” Trump wrote on Twitter on Friday.

Yet in states Trump won alone, Obamacare has helped millions of people get life-altering — sometimes life-saving — care. Some of them are the same struggling white-working-class voters Trump pledged to champion. A central part of Obamacare is aimed at the working poor: the expansion of Medicaid, a government insurance program for low-income people.

Paul Ryan reads from a list of states with increasing health insurance premiums at his weekly news conference in Washington on Thursday. (Chip Somodevilla)

Obamacare caused the Arkansas uninsured rate to plummet from 23 per cent to 10 per cent between 2013 and 2015, one of the biggest drops in the country, according to Gallup. More than 330,000 Arkansans, a giant 11 per cent of the state population, have gained insurance through the state’s customized version of the Medicaid expansion.

When Arkansans were polled in 2014 for their views on that Medicaid expansion — “Arkansas Works,” which uses federal money to buy private insurance for most of the newly eligible — 48 per cent said it should be continued, 33 per cent said it should be ended. But when the pollster asked the question with the word “Obamacare” in it, support fell to 35 per cent while opposition rose to 39 per cent.

In other words, what some of them appear to dislike is not what the law actually does but who passed it. Such results, replicated in other red states, suggest that even some Arkansans who oppose “Obamacare” do not necessarily want to abandon the components of the Affordable Care Act.

“I think it’s perceived very negatively and very viscerally in a symbolic sense. I don’t think there is serious objection to many of the features of Obamacare,” said Hal Bass, a political science professor at Ouachita Baptist University in Arkansas. “I think the symbolism associated with it is simply toxic in the state.”

Trump and congressional Republicans have said they want to keep popular parts of the law, like the ban on insurers denying coverage to people with “pre-existing conditions,” while eliminating the unpopular parts and slashing prices. But experts have expressed doubts that this is possible, and Republicans have struggled to agree on a replacement.

A plan from Trump’s nominee for health secretary, Obamacare foe Rep. Tom Price, would eliminate the Medicaid expansion in favour of tax credits that would likely leave millions without equivalent coverage.

Bacon started having serious health problems in her 30s. Without insurance, the medical bills that piled up on her table ate every spare cent. When she couldn’t afford to see specialists or pay for her prescriptions, she would try to fortify herself with vitamins.

Then she got Medicaid. When she was diagnosed with cancer in February and had to temporarily shutter her barbecue joint, what happened next was a dream. She was whisked from appointment to appointment, double mastectomy to reconstruction, all for free.

“I was treated like royalty. Very different from what I’m very used to,” she said. “I don’t know if you’d even be talking to me. I could have died. It’s very well that I could have. It did save my life.”

Bacon said she doesn’t know much about politics, and she couldn’t bring herself to vote for either Trump or Hillary Clinton, the Democrat who vowed to protect and improve Obamacare. Clinton, she said, was unethical.

She said her decision not to vote has weakened the power of her complaints. But if she had a chance to talk to her Republican representatives, she said she would simply tell them her story.

“Basically all I’ve got is my story. Hopefully it would get into their hearts,” she said. “Get into their hearts and make them rethink it.”

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